Aeras, a Rockville, Md.-based non profit organization focused on developing vaccines and other products to prevent TB, announced on January 31, 2012 that the National Institute of Allergy and Infectious Diseases (NIAID), part of the United States National Institutes of Health (NIH), has joined as a partner for a Phase II proof-of-concept clinical trial testing the safety and effectiveness of an investigational booster TB vaccine candidate jointly developed by Aeras, and Dutch biopharmaceutical company Crucell.

The trial began in October 2010 and is now ongoing at three sites in Kenya, South Africa and Mozambique. It is sponsored by Aeras and receives funding from Aeras, Crucell and the European and Developing Countries Clinical Trials Partnership. The trial, which will enroll HIV-uninfected infants ages 16 weeks to 26 weeks, is testing the AERAS-402/Crucell Ad35 candidate TB vaccine as a booster immunization to the current Bacille Calmette-Guérin (BCG) TB vaccine. In countries where TB is highly endemic, the World Health Organization (WHO) recommends that all infants receive the BCG vaccine at birth. It is not routinely administered to infants in the United States. The BCG vaccine, first administered to humans in 1921, is the only licensed TB vaccine and reduces the risk of some forms of TB in children. However, it provides limited protection against adult pulmonary TB, the contagious and most common form of TB.

To allow for increased enrolment, the study is now being expanded to include up to six NIAID-supported clinical trial sites in sub-Saharan Africa. The first of these sites to join the trial is the Perinatal HIV Research Unit at the Chris Hani Baragwanath Hospital in Soweto, South Africa. Additional IMPAACT sites are expected to participate in the clinical trial when the next stage of enrolment opens in several months.

The AERAS 402/Crucell Ad35 vaccine is being given as a booster immunization to healthy infants who received the BCG vaccine at birth to determine if the investigational vaccine can increase protection against TB. The recombinant vaccine uses a live, non-replicating adenovirus (Ad35) to deliver three specific Mycobacterium tuberculosis antigens designed to stimulate the immune system and protect against TB. The vaccine does not contain live TB and cannot cause vaccinated infants to become infected with TB. The investigational vaccine had an acceptable safety profile in previous clinical trials among healthy adults and infants, as well as among HIV-infected adults and adults with latent TB.

The study was approved by ethics committees at each participating site as well as by national regulatory authorities in each of the participating countries. Additionally, an independent data and safety monitoring board regularly reviews the study data to ensure the protection of the study participants. Informed consent by a parent or legally authorized representative is required to enrol an infant into the study. The study is expected to be completed in 2015.

“We are pleased to be able to tap into our existing HIV/AIDS clinical research infrastructure to help test promising investigational vaccines against TB,” said NIAID Director Anthony S. Fauci, M.D. The sites are funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

NIH has a long history of supporting TB vaccine development. However, this is the first time that NIH is leveraging its HIV/AIDS clinical trial networks to advance a tuberculosis vaccine candidate. Along with the recent announcement of NIAID’s new partnership in a Phase III TB drug trial, this collaboration follows the NIAID plan to leverage infrastructure originally intended for HIV-related clinical trials to also advance tuberculosis vaccine and therapeutic research for both HIV uninfected and infected populations.

“NIAID’s involvement in this important clinical trial will maximize return on U.S. government investment in clinical research infrastructure while accelerating progress against the world’s deadliest infectious disease after HIV/AIDS,” said Mary Woolley, CEO and President of Research!America, the nation’s largest not-for-profit public education and advocacy alliance committed to research.

“Our novel collaboration with NIAID comes as multiple TB vaccine candidates are poised to enter efficacy trials requiring thousands of participants and significant investment, as well as complex infrastructure and sophisticated expertise. We are grateful for the partnership of one of the most well-respected biomedical research institutes in the world, and the opportunity to utilize well-established clinical sites”, said Jim Connolly, President and CEO of Aeras.

According to the WHO, in 2010 TB sickened 8.8 million people and killed 1.4 million people worldwide. It is a leading cause of death among people who are also infected with HIV. In Africa, there were an estimated 2.3 million TB cases and 254,000 TB deaths in 2010. Safe and effective vaccines hold promise for protecting these at-risk populations.

Shobha Shukla - CNS(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also co-authored a book (translated in three languages) "Voices from the field on childhood pneumonia" published in November 2011 and a report on Hepatitis C and HIV treatment access issues in December 2011. Email: shobha@citizen-news.org, website: http://www.citizen-news.org)